Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation.

Farhanul Huda,Sarama Saha,Sudhir K Singh

doi:10.5005/jp-journals-10018-1246

Farhanul Huda, Sarama Saha + Show 1 more

Open Access

https://doi.org/10.5005/jp-journals-10018-1246

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Abstract

Spontaneous perforation of extrahepatic biliary system is a rare and potentially fatal cause of acute abdomen. Clinical presentation is as biliary peritonitis. This condition is rarely suspected as a cause of peritonitis preoperatively and correct diagnosis is made during surgery. If suspected, diagnosis can be made by various imaging techniques like hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). As these imaging techniques are not readily available, especially in low socioeconomic countries, we hereby report a case of spontaneous common bile duct (CBD) perforation, which was diagnosed preoperatively by estimation of ascitic fluid-to-serum bilirubin ratio, a simple, quick, and cost-effective test.How to cite this article: Huda F, Naithani M, Singh SK, Saha S. Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation. Euroasian J Hepato-Gastroenterol 2017;7(2):185-187.

Highlights

Spontaneous perforation of the common bile duct (CBD) is a rare disease in adults.[1]
Preoperative diagnosis is made by hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP), which are expensive and not readily available.[2,3]
We report a case of spontaneous CBD perforation that was diagnosed preoperatively by a simple and cost-effective test

Summary

INTRODUCTION

Spontaneous perforation of the CBD is a rare disease in adults.[1]. Acute onset and delay in diagnosis lead to increased morbidity and sometimes mortality. With the finding of cholelithiasis, bile-tinged ascites, and the ascitic fluid/serum bilirubin ratio of 8.01, a preoperative diagnosis of spontaneous perforation of extrahepatic biliary tree was made and the patient was taken up for exploratory laparotomy. Post-ERCP.[5] The commonest presentation is insidious onset of progressive jaundice and abdominal distension.[6] Owing to its rarity, the diagnosis of spontaneous CBD perforation is usually made peroperatively.[3] A preoperative diagnosis can be made with the help of cholescintigraphy, MRI, ERCP, or CT. These tests are costly and not readily available. Primary repair of CBD is considered hazardous due to local inflammation

CONCLUSION

DISCUSSION